162 Abstracts/Lung Cancer I4 (1996) 149-I 79

Enlarged mediastinal nodes as markers of involvement by Characteristics of non-small cell lung cancer 3 cm or less in NSCLC diameter Ren S-H, Xu S-J, Huang Y. LishuiPreSeclu~alHospital. Zhejiang. Chin J Clin Oncol. 1995;22:548-50.

Theresultsofhistologicalobservationonmediastinalnodesresected in 5 6 cases of non-small cell lung cancer were analysed. Enlarged mediastinal nodes with diameter greater than 1 .O cm presented in 52 cases (92.9%). including 11 cases of presumed N, disease and 41 cases ofpresumed N, diseases. But only 19 true N2 diseases were confirmed by pathological examination, including 3 N, disease and 16 N, disease. One true N, disease was found in 4 presumed N, disease. Presumed N, disease was given to in all 16 cases of squamous carcinoma, however only 2 were true (11. I %). On the other hand 14 true N, disease (56%) presented in 25 cases of adenocarcinoma with presumed N, disease (P < 0.01). Hence, it is impossible to assess N disease and stage of lung cancerpreoperatively by the size ofnode, especially in case of squamous carcinoma. Thoracotomy is advisable in cases of enlarged mediastinal nodes when the histological evidence of mediastinal involvement is not available.

Tateishi M, Fukuyama Y, Hamatake M, Kohdono S, Mitsudomi T, lshida T et al. Deparrment of Surgery II. Faculty of Medicine. Kpshu University, 3-l-l Maidashi, Higashi-ku. Fukuoka 812. J Surg Oncol 1995;59:251-4.

We retrospectively investigated 308 cases of non small cell lung cancer of %3 cm diameter. There were 204 adenocarcinomas, 78 squamous cell carcinomas, 15 large cell carcinomas, and 11 other carcinomas. AccordmgtoTNMstaging, there wereone case stagea, stage I, 22 stage II, 49 stage IIIA, 15 stage IIIB, and 13 cases stage IV. TI disease was seen in 262 cases, T2 in 19, T3 in 10, T4 in 16, and Tis in 1. NO disease was seen in 217 cases, Nl in 30, N2 in 60, and N3 in 1. The 5-year survival rate of al1 cases was 63%. There were statistically significant differences amour T status (Tl vs. T3 , T4), N status (NO vs. NI, N2), andM status (MO vs. MI) (P<O.Ol). The 5- year survival rates of cases with adenocarcinoma and squamous cell carcinoma were 60% and 64%, respectively. In 204 cases of adenocarcinoma, T3 disease was found in one case, T4 disease in I5 (7%), and nodal involvement (Nl + N2) was present in 69 (34%). In 78 cases of squamous cell carcinoma T3 wasseen in 6(8%),T4 in 1, andnodal involvement in 14( 18%). The incidence of T3 disease, T4, and N(+) varied significantly according to histology (P < 0.05). Our investigation suggested that cases of small- sized lung cancer were often at an advanced stage at detection, and that the spread of disease differed according to histology. The patient with small-sizedlungcancershouldbeofferedastandardoperationregardIess of histology.

The treatment of patients with recurrent brain metastases: A retrospective analysis of 109 patients with nonsmall cell lung cancer Arbit E, Wronski M, Burt M, Galicich JH. Neurosurgery Service. Memorial Sloan-Ketrering Cancer Cm. 12 75 York Avenue, New York, NY 10021. Cancer 1995;16:165-13.

Background. Brain metastases representamajor source ofmorbidity in patients with cancer. Merhods. Treatment outcomes were analyzed retrospectively in 214patients with brain metastases Born nonsmall cell lung cancer (NSCLC) who underwent resection at Memorial Hospital (New York, NY) between January, 1976, and December, 1990. Results. The study group included 109patients(5l%)withsymptomaticrecurretn braintumors(median,5.0 monthsaftercompleteresection). Recurrence in the brain was at the original site in 62% of patients and at other sites in 30%. The median survival (MS) was Il.3 months in the recurrence group compared with 9.5 months (P < 0.5) in the nonrecurrence group (N = 105). Thirty-two patients had further surgery after recurrence; their median relapse time was 5.2 months. In these patients, survival (MS, 15.0 months) calculated from the time of their first operation, was significantly different (P < 0.001) from that of patients who did not undergo a second procedure (N = 77) (MS, 10.0 months). In the 32 patients who underwent reoperation, MS from the time of the second operation was 10 months, whereas the median interval from the first operation was 5 months (average, 5.7 months). Eight ofthese 32 patients had a third operation, after a median relapse time of4 months; their MS was 42 months. There was a significant difference (P < 0.02) between the MS of 39 patients synchronously diagnosed with lung cancer and brain metastasis (MS, 9.0 months) and 70 metachronously diagnosed patients (MS, 14.6 months). Women (N = 55) survived longer than men (N = 54) (14.4 months vs. 9.7 months, P < 0.01). Univariate analysis showed that histology, disease stage, and completeness of resection of the primary tumor also affected survival (P < 0.02, P < 0.014, and P < 0.001, respectively). Although no significant difference was found between survival of patients with recurrence in the supratentorial space and patients with recurrence in the posterior fossa (MS, 1 I .4 months vs. 11.2 months, P < 0.13), no one from the latter subgroup survived 3 years.

Conclusions. If technically feasible, further surgery is effective in prolonging the survival of patients with NSCLC who have recurring brain metastases.

Measurement of serum pro-gastrin-releasing peptide as an indicator for monitoring therapeutic effects in patients with small cell lung carcinoma Kodama T, Nishiwaki Y, Hojo F. Division ofRespiratory Oncology, National Cancer Cenrer Hospital. Kashiwa. Jpn J Chest Dis 1995; 54:625-30.

In 17 cases with small cell lung carcinoma (SCLC), we measured serum progastrin-releasing peptide @roGRP) more than four times during from the start of chemotherapy to 36 months thereafter. The elevated serum proGRP was noted in 14 of 17 cases with SCLC before the chemotherapy. In the non-recutrent groups (n = 6), serum proGRP levels remained within normal limits. In the recurrent group (n = 1 I), eight cases with SCLC showed abnormally elevated serum proGRP levels before the chemotherapy. In five cases of them, serum proGRP showed abnormal levels at the time of 7,6,5,4, and 1 months before the recurrence was clinically confirmed. In the remaining three cases there was no elevation of serum proGRP after the recurrence. In the rest three cases, serum proGRP was within normal limits before the treatment and sustained within normal limits after the recurrence. From the above mentioned tindiigs, it was concluded that serum proGRP was a useful indicator for monitoring therapeutic effects in patients with SCLC.

Axillary lymph node metastases of bronchogenic carcinoma Marcantonio DR. Libshitz HI. Diagnosfic Radiology Deparfmenl. Texas Univ. M.D. Andemon Can. Ctr.. Box 57. 1515 Holcombe Blvd.. Houston. TX 77030. Cancer 1995;16:803-6.

Background. Metastasis of bronchogenic carcinoma to aXiIlat’y lymph nodes is rare. The pathways and possible significance ofaxillary lymphnodemetastasis from bronchogenic carcinomawere investigated. Merhods. Seventeen patients with probableaxillary lymphnode metasta- ses from bronchogenic carcinoma were identified by computed tomography. There were 15 nonsmall cell lung cancers and 2 small cell lung cancers. Axillary lymph node metastasis was proven by biopsy in